Document Type: RESEARCH PAPER
Authors
- Alexis A. Williams 1
- Eric H. Tischler 2
- Daniel Sholder 2
- Thema A. Nicholson 2
- Mitchell G. Maltenfort 2
- Charles Getz 2
- Gerald Williams Jr 2
- Surena Namdari 2
1 Sidney Kimmel Medical College at Thomas Jefferson University, Department of Orthopaedics Surgery, Philadelphia, PA
2 The Rothman Institute, Thomas Jefferson University, 925 Chestnut St. 5th Floor, Philadelphia, PA
Abstract
Purpose
Purpose
The purpose of this study was to determine patient-specific risk factors and clinical intervention rates for abnormal postoperative Chem-7 panels in shoulder arthroplasty patients.
Methods
Retrospectively, all primary anatomic total (aTSA) and reverse shoulder (RTSA) arthroplasties (between 2007-2013) performed at a single institution were identified. All patients underwent routine preoperative and postoperative day one (POD1) chemistry panels. Each clinically significant component of the Chem-7 panel was independently evaluated using a multivariate analysis to identify risk factors for abnormal results. Associated clinical intervention rates were also calculated.
Results
Data from 1,012 patients (248 RTSA; 764 aTSA) was analyzed. 5.4% of patients had at least one preoperative abnormal chemistry result. On multivariate analysis, patients with abnormal preoperative Chem-7 labs and a history of renal disease had significantly increased risk for abnormal POD1 labs (p <0.001). Although 25.6% (259/1,012) of patients had at least one abnormal POD1 lab result, the total postoperative clinical intervention rate was 15.1% (39/259).
Conclusion
Renal disease and a preoperative abnormal chemistry result are important risk factors for abnormal postoperative Chem-7. Optimizing renal status and correcting abnormal blood chemistry results preoperatively may reduce the incidence of abnormal postoperative chemistry results.
Keywords
- Blood chemistry
- Laboratory order
- Reverse shoulder arthroplasty
- Risk stratification
- Total Shoulder Arthroplasty
Main Subjects
1. Kraft MD, Btaiche IF, Sacks GS, Kudsk KA. Treatment
of electrolyte disorders in adult patients in the
intensive care unit. Am J Health Syst Pharm. 2005;
62(16):1663-82.
2. Tambe AA, Hill R, Livesley PJ. Post-operative
hyponatraemia in orthopaedic injury. Injury. 2003;
34(4):253-5.
3. Anthony CA, Westermann RW, Gao Y, Pugely AJ,
Wolf BR, Hettrich CM. What are risk factors for 30-
day morbidity and transfusion in total shoulder
arthroplasty? A review of 1922 cases. Clin Orthop
Relat Res. 2015; 473(6):2099-105.
4. Jiang JJ, Toor AS, Shi LL, Koh JL. Analysis of perioperative
complications in patients after total shoulder
arthroplasty and reverse total shoulder arthroplasty.
J Shoulder Elbow Surg. 2014; 23(12):1852-9.
5. Waterman BR, Dunn JC, Bader J, Urrea L, Schoenfeld
AJ, Belmont PJ Jr. Thirty-day morbidity and mortality
after elective total shoulder arthroplasty: patientbased
and surgical risk factors. J Shoulder Elbow Surg.
2015; 24(1):24-30.
6. Day JS, Lau E, Ong KL, Williams GR, Ramsey ML, Kurtz
SM. Prevalence and projections of total shoulder and
elbow arthroplasty in the United States to 2015. J
Shoulder Elbow Surg. 2010; 19(8):1115-20.
7. Freeborn DK, Baer D, Greenlick MR, Bailey JW.
Determinants of medical care utilization: physicians’
use of laboratory services. Am J Public Health. 1972;
62(6):846-53.
8. Schleicher E. The clinical chemistry laboratory:
current status, problems and diagnostic prospects.
Anal Bioanal Chem. 2006; 384(1):124-31.
9. Kreines A, McMillan S, Ford E, Dingle A. Reverse total
shoulder arthroplasty for the treatment of synovial
chondromatosis: a case report and review of the
literature. Arch Bone Jt Surg. 2017; 5(2):117-20.
10. Epstein M. Aging and the kidney. J Am Soc Nephrol.
1996; 7(8):1106-22.
11. Murphy AM, Tunitsky-Bitton E, Krlin RM, Barber
MD, Goldman HB. Utility of postoperative laboratory
studies after female pelvic reconstructive surgery. Am
J Obstet Gynecol. 2013; 209(4):363.e1-5.
12. Perrone RD, Madias NE, Levey AS. Serum creatinine
as an index of renal function: new insights into old
concepts. Clin Chem. 1992; 38(10):1933-53.
13. Kamath AF, McAuliffe CL, Kosseim LM, Pio F, Hume E.
Malnutrition in joint arthroplasty: prospective study
indicates risk of unplanned ICU admission. Arch Bone
Jt Surg. 2016; 4(2):128-31.
14. Feinfeld DA, Bargouthi H, Niaz Q, Carvounis CP.
Massive and disproportionate elevation of blood urea
nitrogen in acute azotemia. Int Urol Nephrol. 2002;
34(1):143-5.
15. Stark JL. BUN/creatinine: your keys to kidney function.
Nursing. 1980; 10(5):33-8.
16. Stookey JD, Pieper CF, Cohen HJ. Is the prevalence of
dehydration among community-dwelling older adults
really low? Informing current debate over the fluid
recommendation for adults aged 70+years. Public
Health Nutr. 2005; 8(8):1275-85.
17. Robinson BE, Weber H. Dehydration despite drinking:
beyond the BUN/Creatinine ratio. J Am Med Dir Assoc.
2004; 5(2 Suppl):S67-71.
18. Thomas DR, Tariq SH, Makhdomm S, Haddad R,
Moinuddin A. Physician misdiagnosis of dehydration
in older adults. J Am Med Dir Assoc. 2004; 5(2
Suppl):S30-4.
